Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Hair removal facts

Hair insulates the skin against temperature changes and is a barrier to foreign objects.

Removing hair is almost always done for perceived cosmetic or social reasons.

Certain hair-removal techniques can damage the skin and produce dark spots that may last a long time.

Depilation is hair removal above the level of the pore (follicular opening).

Epilation is the damaging of both the hair and the hair bulb below the level of the skin surface.

What are the different types of hair?

All hair is dead protein. Hair's superficial appearance depends upon its anatomical location. Fine poorly pigmented hair tends to grow on certain parts of the face like the upper cheeks and forehead. Thick darker hairs grow on the edges of the eyelids and brows, the male jaw-line, the scalp, nostrils, and pubic areas. These characteristics often change as one ages. The palms, soles, and the red portion of the lips do not have hair or hair follicles.

What are the pros and cons of electrolysis?

Electrolysis procedures involve threading a thin wire into a single follicle and then applying an electric current. Depending on the nature of the device, the hair follicle is destroyed either by the production of heat or sodium hydroxide. This process is painful and requires each follicle to be treated individually so that it is quite time-consuming. Multiple treatments of a follicle are often necessary to achieve permanent destruction. Pigmentation at the site of treatment is common. Since each follicle is treated individually, electrolysis of large areas is quite arduous.

Presciption Medications for Hair Removal

Vaniqa

Eflornithine is the first topical drug (used on the skin) for the treatment of unwanted facial and chin hair. It does not remove the hair but rather slows its growth. The cells surrounding the base of each hair (called the hair follicle) undergo rapid growth and maturation as they transform into hairs. Certain proteins called polyamines are needed for this rapid cell growth and differentiation, and the production of these polyamines depends on the activity of an enzyme, ornithine decarboxylase (ODC). Eflornithine is believed to block ODC, slowing the growth and differentiation of the cells within the hair follicles. Eflornithine was approved by the FDA in July 2000.

What are the pros and cons of laser hair removal?

Laser light is absorbed by pigment in the hair causing the production of heat that can be used to destroy both the hair and adjacent tissues. When done correctly in the appropriate patient, only the follicular tissues are damaged resulting in local hairlessness for an extended period of time. The process may have to be repeated several times before there is any permanent result. Those with contrasting light skin color and dark hair are the easiest to treat where as those in whom there is little color difference between skin and hair can be challenging. Those with darker skin often require lasers that generate longer wavelength light. Occasionally, it may be necessary to add an exogenous pigment to the hair if the hair is naturally uncolored. Laser hair removal is relatively expensive and should only be performed by an experienced operator. Laser hair removal can be painful. Poor results are frequently due to darkening of the treated skin and actual thermal burns. There are laser and light systems (Tria, E-ONE, Silk'n, and No!No! are trade names for use-at-home devices.) available for use at home by the untrained consumer. Whether this is a safe and effective approach to hair removal remains to be seen.

What are the pros and cons of shaving?

Depilation is hair removal above the level of the pore (follicular opening). Shaving is the most popular and cheapest type of depilation, and if performed safely, it results in a satisfactory appearance. In order to minimize follicular irritation (folliculitis), one should move the razor in the same direction that the hairs seem to be growing and pull the razor blade over the skin smoothly and evenly for only a single pass. It is important to use a good lubricant to reduce friction between the blade and the skin. It is also important to use a very sharp blade. Electric razors seem to be somewhat less likely to produce irritation, but repeated passes can produce folliculitis. Safe shaving technique does not produce perfectly smooth skin. There should be a short fragment of hair that remains, extending above the surface of the skin. Shaving must be repeated frequently. There are devices (No!No!) available for home use that "shave" hair by burning it close to the skin surface. This is probably no more effective than shaving.

What are the pros and cons of depilatory creams?

Depilatory creams (Nair, Veet) rely on chemical means to destroy the hair shaft by breaking disulfide bonds of the hair proteins. They require a three- to five-minute application to be effective. They produce a softer feel to the severed shaft than does shaving. Chemical depilatories may produce irritation or dermatitis in certain sensitive individuals.

What are the pros and cons of sugaring and waxing?

These are two ancient techniques used to remove hair over larger body surfaces. These methods involve applying a molten solution of sugar-impregnated cloth or wax. After these solutions solidify, they are abruptly yanked away from the skin, pulling out the adherent hairs. It is necessary for the hairs to be long enough to be "grabbed" by the material. These types of procedures can be quite painful. If the solutions are too hot, skin burns can occur.

What are the pros and cons of plucking and tweezing?

Plucking or pulling hairs out one at a time is a very effective but tedious method of depilation. This can result in sufficient inflammation to produce dark spots around plucked follicles. Permanent hair loss can ensue if plucking is performed repeatedly over long periods of time.

What are the pros and cons of twist-threading?

This is an ancient method of depilation popular in the Middle East. A skilled practitioner holds a twisted length of thread in one hand while the other end is held in the mouth or in the other hand. Then hairs are trapped in the twisted thread and pulled out. Although this can be performed by oneself, it probably is more easily accomplished by a technician. It is reasonably costly and must be repeated frequently.

Do any prescription medications or products stop hair growth?

There is a prescription medication, eflornithine cream (Vaniqa), that inhibits hair growth by inhibiting an enzyme in the hair follicle that is required for hair growth. This does not result in a permanent hair removal since after the medication is no long applied the enzyme reestablishes hair growth. Of note, many prescription medications for illnesses and conditions can affect the growth of hair as side effects.

Which hair-removal method provides the longest lasting results?

Epilating methods are the only techniques likely to produce long-term permanent results. Those are electrolysis and laser hair treatment.